FS07. Plan to Change

Jun 27

Welcome to the Family Support Group Program.

Here you can download the session PDF below by clicking on the button or continue scrolling to the online version. The videos password is craft.

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CHECK-IN SECTION – Maximum time 20 minutes

Mindful Minute -- take a break from what you have been doing, breathe deeply, relax and recharge.

Step 1: Find a comfortable seated position with both feet grounded on the floor. Put a hand on your stomach. Close your eyes.

Step 2: Take a deep breath in through your nose and out through your mouth. Notice your thoughts and feelings and any tensions in your body.

Step 3: As you inhale and exhale, breathe deeply so your belly fills and empties with air. The hand on your stomach helps you practice belly – not chest breathing.

Step 4: For the next minute make breathing in and out your only focus. Let your thoughts come and go without trying to control them. If you find an area of tension in your body, relax it and let the tension go.

Step 5: At the end the minute slowly open your eyes. Gently bring your presence back to your surroundings.

Our Purpose

CRAFT Connects’ Family Support groups are for parents, partners, families and other Concerned Significant Others (CSOs) who have a loved one that is struggling with a substance use or mental health disorder. We know from first-hand experience that loving someone with these challenges can be a difficult, lonely journey. To create a safe place for honest sharing of our lived experience we use appropriate language and behavior. We are empathetic, nonjudgmental, genuine, respectful, steer clear of confrontation and imposing our own solutions. We encourage hope and compassion for all. CRAFT Connect helps to reframe and energize connections between you, your loved one and behavioral health professionals into a “therapeutic alliance” that leads to progress and healing. There is a lot we can learn from one another.

Last week we studied the “FS09. Abuse/Domestic Violence Precautions” session:

A. Were you able to follow through on these commitments?

· Develop a Self-Protection Plan. (Circle one) Yes, No

B. What experience did you have practicing or sharing last session’s principles and skills?

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C. What did you do to purposefully take care of yourself?

LEARN SECTION – Maximum time 30 minutes

1. Change is a process, not an event (see “Cycle of Change Handout” accompanying this session). Helping our loved one to make changes won’t happen without deliberate effort. We are learning principles and skills to change the way we interact with our loved one to try and influence them in positive ways. We can deliberately use CRAFT Connect skills to bring about intentional, incremental changes. These changes are stepping stones to the bigger change we hope for -- that our loved one will prefer a life without unwanted behaviors, enter or stay in treatment and recover. Helping your loved one make positive changes involves planning. Planning identifies the things you want to be different in your life particularly as they relate to your loved one’s unwanted behavior. Effective plans are outcome driven, written, and focused on what we want to achieve. While effective plans are written, they are not written in stone. They are flexible, and in fact, need to be open to change as things in our and our loved one’s lives change.

Discuss: Can you share a story of when you made positive changes in any part of your life (sports, academics, relationships, health, etc.) by using a specific written plan? _______________________________________________________________________________________ _______________________________________________________________________________________________________________

2. Before we get started planning let’s get on the same page with some terms that often get mixed up -- plans, goals, and objectives. Here are some simple definitions to keep us on track for this discussion.

● A plan is where we want to end up. It helps us identify what we specifically want to be different.
● Goals are pieces of the plan. Goals help us get more specific; they are steps along the way in completing the plan
● Objectives are the things that we need to do in order to achieve the goal. Think of it this way; objectives are typically, visible. If you can see someone doing something, that something is an objective.

3. Professional treatment plans developed for those with behavioral health disorders are built around the problem areas they bring into treatment. (See “Sample Treatment Plan Handout” accompanying this session). Problems cannot be vague; they must be specific. Like with treatment planning, the first step in planning to change is to identify what the problem is, what we want to be different in our or our loved one’s life. When we get specific, we use that information to set goals and then objectives that can lead to the change we want.

4. Turn to the “Problem Solving Worksheet” accompanying this session and let’s go through its seven steps. Step 1: What is the Problem? Individually, identify an acute or troubling smaller unwanted behavior caused by your loved one’s disorder that you want to be different, to change. Try not to think about the big problem, like my daughter suffers from depression, instead think of a specific behavioral problem. Try to keep it to one sentence. For example, My daughter won’t take medication to help with her depression disorder. Now add more detail about the physical, emotional or behavioral evidence that the problem identified actually exists. Getting specific will help you think through what you can do to bring about changes (Meyers and Wolfe, 2004). For example, My daughter won’t take medication to help with her depression disorder, so I end up nagging, pleading or threatening her, and I hate that. I want her to be responsible, but I don’t want her to miss taking the medication.

Discuss: Why is it helpful to break large complicated problems into smaller more specific problems. How can taking the time to dig deeper into what you want to be different be helpful in planning to change? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Step 2: Check the Facts. If the facts are correct then go to Step 3. If the facts are not correct, go back to Step 1 and identify another problem to work on.

Discuss: Why is it important to take the time to Check the Facts?
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6. Step 3: Set Goals. Once you have identified a specific problem and checked the facts, ask yourself what do I or my loved one need to do to change. Goals are the condition you expect to change in you or your loved one. They help us identify the incremental changes we need to make in order to move the plan along. Goals tend to be the broader positive impact we want to see, they become stepping stones to our overall plan. Effective goals help identify specific objectives, which we will get to. For now, think more about the broader positive impact you want to see (Meyers and Wolfe, 2004, p. 75).

7. Look at your loved one’s problematic behavior identified in Step 1. What goal do you want to set that could help address that problem? If the example problem is, My daughter won’t take medication to help with her depression disorder, so I end up nagging, pleading or threatening her, and I hate that. I want her to be responsible, but I don’t want her to miss taking the medication. A goal could sound something like this: I want to learn how to talk to my daughter about taking her medication without it turning into a daily fight. I want to determine if there is a good time to approach her and just exactly how to start that conversation.

Watch: “Five Rules of Goal Setting: How to set SMART, Motivating Personal Goals” video.

8. Step 4: Brainstorm Potential Objectives. Effective goals get into the specifics of what you need to do in order to achieve the goal. These specifics are objectives. If you can see your loved one being sober on weeknights, taking their medication or using positive “I” communication, those are objectives. Objectives are a way to measure if we have achieved our goal. Turn off your internal editor and brainstorm potential objectives. Think of as many objectives as you can. Ask for suggestions from people you trust. Do not dismiss any ideas. Make sure they are all S-M-A-R-T, Specific, Measurable, Attainable, Relevant, and Time bound.

9. Step 5: Pros and Cons. Choose the three best solutions or objectives that would help you attain your goal. Think about what might get in the way of achieving these objectives and how you could overcome the obstacles. For example, My daughter is not a morning person, so we will talk in the afternoon or early evening. Step 6: Pick One Objective. Staying with our example, if the goal is to communicate effectively and positively with your daughter about taking her medication an objective might sound something like, This week I will study and practice positive “I” communication strategies for 30 minutes every day. Then, beginning on the 15th, I will use positive I communication with my daughter when talking about her taking her medication. (Positive I or “PIUS” communication are introduced in the “FS02. Effective Communication” session.)

Discuss: What did you notice that made the objective example effective? How does it relate directly to the broader goal? Why is anticipating potential obstacles important? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. Step 7: Try It. “Once you have a plan of action, try it. But don’t do what you’ve done all these years – trying and trying and trying. This time try it as a scientist. That means implementing your plan and keeping track of how it works. This way you will be able to tell exactly how well it worked, or if you fell short, just what parts need adjustment.” (Meyers and Wolfe, 2004, p. 128) Develop a plan for implementing your objective, including measures and how progress will be monitored. Staying with our example: When I start using positive I communication the afternoon of the 15th, I will begin tracking my daughter’s response by her daily medication. Step 8: How Did it Go? If the objective helped achieve your goal, celebrate. If it didn’t work, go back to Step 4 and pick another objective to try.

11. Don’t feel like you have to tackle all of the problems at once. Focusing on one goal and supporting objectives is just the first step. Imagine what could happen if you looked at other unwanted behaviors besides the one selected, and set goals and objectives to help your loved one make positive changes in those areas. “It will never be the case that you decide on a way of responding to a person or situation and never have to modify it. From day to day to month to year, we change. Do not be discouraged if your plans do not work perfectly the first time or the fiftieth time. Just keep tracking and refining. It will come together for you.” (Meyers and Wolfe, 2004, p. 130).

GROUP SHARING SESSION – Maximum time 30 minutes

12. We will now begin the sharing portion of the meeting. You are invited to share from 3 to 5 minutes about your experience as it relates to your loved one’s recovery, this week’s session or what you are currently working on. Please focus your sharing on potential solutions rather than the problems. We will conclude the sharing five minutes before the end of the meeting. Who would like to begin?

COMMITMENTS SESSION – Maximum time 10 minutes

13. Please remember that what has been shared here is confidential and that the opinions expressed are of the individuals who shared them. These are our group commitments, we will start the next CRAFT Connect session by reporting on them. This week I will:

A. Do the in-between session assignments

· Identify one thing you want to be different. Use the “Problem Solving Worksheet” to start planning to change.

B. Share what I am learning with my family, friends and community.

C. Show kindness for myself by self-care.

As you listen to this “Song About Connection”, take a few minutes to quietly think about what you learned in this session. Write your thoughts and personal commitments below.

Watch: “Lean on Me - Bill Withers (Lyrics)” video.

What are the most important things I learned?

What will I do differently because of what I learned?

Cycle of Change Handout

For over 35 years researchers have found that individuals move through a series of six stages (precontemplation, contemplation, preparation, action, maintenance, relapse) in the adoption of healthy behaviors or cessation of unhealthy ones. Research on a variety of different problem behaviors has also shown that there are certain predictors of progression through the stages of change (e.g., Prochaska & DiClemente, 1983), including decisional balance (Prochaska, 1994); self-efficacy (e.g., DiClemente, Prochaska, & Gibertini, 1985); and the processes of change (Prochaska & DiClemente, 1983).

Where do you think your loved one is at in the Cycle of Change, and why?

Precontemplation, not yet acknowledging that there is a problem behavior that needs to be changed. The stage in which an individual has no intent to change behavior in the near future, usually measured as the next 6 months. PR contemplators are often characterized as resistant or unmotivated and tend to avoid information, discussion, or thought with regard to the targeted health behavior (Prochaska et al., 1992).

Contemplation, acknowledging that there is a problem but not yet ready or sure of wanting to make a change. Individuals in this stage openly state their intent to change within the next 6 months. They are more aware of the benefits of changing, but remain keenly aware of the costs (Prochaska, Redding, & Evers, 1997). Contemplators are often seen as ambivalent to change or as procrastinators (Prochaska & DiClemente, 1984).

Preparation, getting ready to change. The stage in which individuals intend to take steps to change, usually within the next month (DiClemente et al., 1991). Preparation is viewed as a transition rather than stable stage, with individuals intending progress to Action in the next 30 days (Grimley, Prochaska, Velicer, Blais, & DiClemente, 1994).

Action, changing behavior. An individual has made overt, perceptible lifestyle modifications for fewer than 6 months (Prochaska et al., 1997).

Maintenance, maintaining the behavior change. These are working to prevent relapse and consolidate gains secured during Action (Prochaska et al., 1992). Maintainers are distinguishable from those in the Action stage in that they report the highest levels of self- efficacy and are less frequently tempted to relapse (Prochaska & DiClemente, 1984).

Relapse. Returning to older behaviors and abandoning the new changes.

This Transtheoretical Model (TTM) of change in health psychology explains or predicts a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made. TTM — currently, the most popular stage model in health psychology (Horwath, 1999) — has proven successful with a wide variety of simple and complex health behaviors, including smoking cessation, weight control, sunscreen use, reduction of dietary fat, exercise acquisition, quitting cocaine, mammography screening, and condom use (Prochaska, et al., 1994).

Sample Treatment Plan Handout

In developing behavioral treatment plan goals and objectives, the ‘client’ must move through the following events:

Identify that he or she has a problem.
Understand how the problem negatively affects the patient.
Learn what he or she is going to change.
Practice the change.

Interventions are selected by looking at what the client needs. They may include every treatment available from any member of the multidisciplinary treatment team. The person responsible for the intervention is listed so the team knows who is responsible (Perkinson, R., 2017).

PROBLEM 1: NORMAN HAS A PATHOLOGICAL RELATIONSHIP WITH ALCOHOL, AS INDICATED BY A BLOOD ALCOHOL LEVEL ON ADMISSION OF .32, THREE DWIS, AND FAMILY REPORT OF DAILY DRINKING

Goal A: Develop a program of recovery congruent with a sober lifestyle, as evidenced by:

Objective 1: Norman will identify with his counselor 10 times when alcohol use negatively affected his life by 6-1-2021.

Intervention: Assign the patient the homework of making a list of 10 times when alcohol use negatively affected his life.